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Huang RR, Chen Z, Kroeger N, Pantuck A, Said J, Kluger HM, Shuch B, Ye H. CD70 is Consistently Expressed in Primary and Metastatic Clear Cell Renal Cell Carcinoma. Clin Genitourin Cancer 2024; 22:347-353. [PMID: 38195301 DOI: 10.1016/j.clgc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND CD70 is commonly overexpressed in renal cell carcinoma and is minimally expressed in normal human tissue, making it a potential therapeutic target for patients with advanced renal cell carcinoma. The expression frequency of CD70 in metastatic renal cell carcinoma is not well established. MATERIALS AND METHODS We assessed CD70 immunohistochemistry in 391 primary renal tumors and 72 metastatic renal cell carcinomas on a tissue microarray including 26 sets of paired primary and metastatic tumors. RESULTS CD70 was frequently overexpressed in clear cell carcinoma, with a significantly lower expression rate in papillary renal cell carcinoma (P < .0001). No expression of CD70 was detected in other types of renal tumors and normal renal parenchyma. In clear cell renal cell carcinoma, CD70 expression was significantly correlated with hypoxia pathway proteins, corroborating with a recent study suggesting that CD70 is a downstream target gene of hypoxia-inducible factor. While higher expression levels were observed in males and non-Caucasians, CD70 expression was not associated with tumor grade, sarcomatoid differentiation, stage, or cancer-specific survival. Further, analysis of 26 paired primary and metastatic tumors from same individuals revealed a concordance rate of 85%. CONCLUSION Our findings validated CD70 as a promising therapeutic target for patients with metastatic clear cell renal cell carcinoma. The utility of primary tumor tissue as surrogate samples for metastatic clear cell carcinoma awaits future CD70-targeted clinical trials.
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Affiliation(s)
- Rong Rong Huang
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Zhengshan Chen
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA; Pathology, Kaiser Permanente Riverside Medical Center, Riverside, CA
| | - Nils Kroeger
- Department of Urology, University of Greifswald, M-V, Germany
| | - Allan Pantuck
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jonathan Said
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | | | - Brian Shuch
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Huihui Ye
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA; Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
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Patel N, Hakansson A, Ohtake S, Muraki P, Proudfout JA, Liu Y, Webber L, Ibarra A, Liu VYT, Davicioni E, Chamie K, Pantuck A, Shuch B. Transcriptomic recurrence score improves recurrence prediction for surgically treated patients with intermediate-risk clear cell kidney cancer. Cancer Med 2023; 12:6437-6444. [PMID: 36397716 PMCID: PMC10028022 DOI: 10.1002/cam4.5399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk stratification of kidney cancer patients after nephrectomy may tailor surveillance intensity and selection for adjuvant therapy. Transcriptomic approaches are effective in predicting recurrence, but whether they add value to clinicopathologic models remains unclear. METHODS Data from patients with clear cell renal cell carcinoma (ccRCC) was downloaded from The Cancer Genome Atlas. Clinicopathologic variables were used to calculate SSIGN (stage, size, grade, and necrosis) scores. The 16 gene recurrence score (RS) signature was generated using RNA-seq data. Transcriptomic risk groups were calculated using the original thresholds. SSIGN groups were divided into low, intermediate, and high risk. Disease-free status was the primary endpoint assessed. RESULTS SSIGN and RS were calculated for 428 patients with non-metastatic ccRCC. SSIGN low-, intermediate-, and high-risk groups demonstrated 2.7%, 15.2%, and 27.5%, 3-year recurrence risk, respectively. On multivariable analysis, the RS was associated with disease-free status (sub-distribution hazard ratio (sHR) 1.43 per 25 RS [95% CI (1.00-1.43)], p = 0.05). By risk groups, RS further risk stratified the SSIGN intermediate-risk group (sHR 2.22 [95% CI 1.10-4.50], p = 0.03). SSIGN intermediate-risk patients with low and high RS had a 3-year recurrence rate of 8.0% and 25.2%, respectively. Within this risk group, the area under the curve (AUC) at 3 years was 0.69 for SSIGN, 0.74 for RS, and 0.78 for their combination. CONCLUSIONS Transcriptomic recurrence scores improve risk prediction even when controlling for clinicopathologic factors. Utility may be best suited for intermediate-risk patients who have heterogeneous outcomes and further refinement for clinical utility is warranted.
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Affiliation(s)
- Neal Patel
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Shinji Ohtake
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Peter Muraki
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Yang Liu
- Veracyte, Inc, South San Francisco, California, USA
| | - Lisa Webber
- Veracyte, Inc, South San Francisco, California, USA
| | | | | | | | - Karim Chamie
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Allan Pantuck
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Brian Shuch
- Department of Urology, Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, California, USA
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Klotz L, Chin J, Futterer J, Hatiboglu G, Pavlovich C, Koch M, Penson D, Relle J, Raman S, Lotan Y, Serrallach M, Heidenreich A, Oto A, Sedelaar J, Tirkes T, Arora S, Macura K, Costa D, Pantuck A, Bomers J, Bonekamp D, Persigehl T, Clarke G, Eggener S. Four-year follow-up of MRI-guided Transurethral Ultrasound Ablation (TULSA) in men with localized prostate cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Drakaki A, Pantuck A, Mhatre SK, Dhillon PK, Davarpanah N, Degaonkar V, Surinach A, Chamie K, Grivas P. "Real-world" outcomes and prognostic indicators among patients with high-risk muscle-invasive urothelial carcinoma. Urol Oncol 2020; 39:76.e15-76.e22. [PMID: 32778476 DOI: 10.1016/j.urolonc.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no current standard of care for patients with high-risk muscle-invasive urothelial carcinoma (MIUC) after neoadjuvant chemotherapy and surgical resection or for those who cannot receive or decline cisplatin-based perioperative chemotherapy. Understanding current, real-world treatment patterns may help inform decisions from clinical, research, and population health management perspectives. We examined real-world treatment patterns, survival outcomes, and prognostic factors among Medicare beneficiaries with high-risk MIUC who did not receive adjuvant treatment after surgical resection. METHODS We identified patients with high-risk MIUC in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database who underwent surgical resection (radical cystectomy and/or radical nephroureterectomy). Eligible patients had indicators of high-risk MIUC and surgical resection between 2001 and 2013. Demographic and clinical characteristics, including comorbidities, American Joint Commission on Cancer (AJCC) stage, tumor stage/grade and nodal status, and distribution of neoadjuvant treatment by the year of surgical resection were evaluated. Overall survival (OS) and disease-free survival (DFS) were assessed for the full cohort and by subgroups using Kaplan-Meier survival analysis. Adjusted Cox proportional hazards models were used to evaluate patient demographics and clinical characteristics associated with OS and DFS. RESULTS A total of 665 patients were included in the analysis, with a mean age of 75.5 years; most were men (61%) and had AJCC stage IIIA disease (69%). Neoadjuvant treatment increased over the entire study period, both overall (from 12% to 46%) and cisplatin based (from 5% to 38%). Median OS for the entire cohort was 23.1 months (95% confidence interval: 18, 27); median DFS was 13.5 months (95% confidence interval: 11.3, 16.8). AJCC stage IIIB/IVA was the most significant predictor of poor prognosis for both OS and DFS, followed by non-white race and comorbidity burden. CONCLUSION The prognosis for high-risk patients with MIUC remains poor, with significant risk of mortality within 2 years of radical cystectomy despite increasing use of neoadjuvant treatment. Unmet treatment needs persist for this difficult-to-treat patient population despite the increasing use of cisplatin-based neoadjuvant chemotherapy.
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Affiliation(s)
| | - Allan Pantuck
- University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | - Karim Chamie
- University of California Los Angeles, Los Angeles, CA
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA
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Klotz L, Chin J, Hatiboglu G, Koch M, Penson D, Pavlovich C, Raman S, Oto A, Fütterer J, Relle J, Lotan Y, Heidenreich A, Serrallach M, Haider M, Bonekamp D, Tirkes T, Arora S, Pantuck A, Zagaja G, Sedelaar M, Macura K, Costa D, Persigehl T, Eggener S. Pivotal trial of MRI-guided transurethral ultrasound ablation in men with localized prostate cancer: Two-year follow-up. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Marshall HR, Shakeri S, Hosseiny M, Sisk A, Sayre J, Lu DS, Pantuck A, Raman S. Long-Term Survival after Percutaneous Radiofrequency Ablation of Pathologically Proven Renal Cell Carcinoma in 100 Patients. J Vasc Interv Radiol 2019; 31:15-24. [PMID: 31767409 DOI: 10.1016/j.jvir.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/14/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the long-term survival of patients treated with percutaneous radiofrequency (RF) ablation for pathologically proven renal cell carcinoma (RCC). MATERIALS AND METHODS In this single-center retrospective study, 100 patients with 125 RCCs (100 clear-cell, 19 papillary, and 6 chromophobe) 0.8-8 cm in size treated with RF ablation were evaluated at a single large tertiary-care center between 2004 and 2015. Technical success, primary and secondary technique efficacy, and pre- and postprocedural estimated glomerular filtration rate (eGFR) at 3-6 months and 2-3 years were recorded. Overall survival, cancer-specific survival, and local tumor progression-free survival were calculated by Kaplan-Meier survival curves. Complications were classified per the Clavien-Dindo system. Statistical testing was done via χ2 tests for proportions and paired t test for changes in eGFR. Statistical significance was set at α = 0.05. RESULTS Overall technical success rate was 100%, and primary and secondary technique efficacy rates were 90% and 100%, respectively. Median follow-up was 62.8 months, ranging from 1 to 120 months. The 10-year overall, cancer-specific, and local progression-free survival rates were 32%, 86%, and 92%, respectively. The number of ablation probes used was predictive of residual unablated tumor (P < .001). There were no significant changes in preprocedure vs 2-3-years postprocedure eGFR (65.2 vs 62.1 mL/min/1.73 m2; P = .443). There was a 9% overall incidence of complications, the majority of which were grade I. CONCLUSIONS Image-guided percutaneous RF ablation of RCCs is effective at achieving local control and preventing cancer-specific death within 10 years from initial treatment.
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Affiliation(s)
- Harry R Marshall
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Sepideh Shakeri
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095.
| | - Melina Hosseiny
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - David S Lu
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Allan Pantuck
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Steven Raman
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
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Aggarwal R, Abida W, Schweizer M, Pantuck A, Nanus D, Heath E, Lakhotia S, Hansen H, Silverman M, Bauman L, Snyder M, Campeau E, Norek K, Attwell S, O'Farrell M, Smith S, Wegge P, Jahagirdar R, Alumkal J. Abstract CT095: A Phase Ib/IIa study of the BET bromodomain inhibitor ZEN-3694 in combination with enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Abiraterone (ABI) and enzalutamide (ENZ) have significant activity in mCRPC yet demonstrate frequent cross-resistance limiting efficacy of sequential androgen receptor (AR) targeting. Bromodomain extra terminal (BET) inhibitors (BETi) down-regulate the expression of putative drivers of ABI/ENZ resistance. ZEN-3694 is an orally bioavailable, potent, and selective BETi with significant anti-tumor activity in ENZ-resistant pre-clinical models. The safety and efficacy of ZEN-3694 in combination with ENZ was evaluated in a phase 1b/2a study in mCRPC (NCT02711956).
Methods: Patients (pts) were required to have progressive mCRPC, prior resistance to ABI and/or ENZ, and no prior chemotherapy for mCRPC. A 3 plus 3 dose escalation schema was utilized, with a starting daily oral dose of ZEN-3694 36 mg plus ENZ 160 mg. Dose expansion was conducted in parallel cohorts at low and high-dose ZEN-3694 (48 and 96 mg daily, respectively). The primary objective was determination of maximally tolerated dose (MTD); key secondary endpoints included time to radiographic progression (TTP) and pharmacokinetic (PK) parameters. Pharmacodynamic (PD) markers included whole blood RNA expression of BETi targets including MYC, IL-8, CCR1, and IL1RN.
Results: 64 pts were enrolled. The median age and PSA at study entry was 70 (range 47 - 89) and 25.9 (range 0.1 - 1701.8), respectively. At study entry, 24 (37.5%) of pts were resistant to ABI, 29 (45.3%) were resistant to ENZ, and 11 (17.2%) to both. ZEN-3694 dose levels ranged from 36 mg to 144 mg daily without reaching a MTD. The most common treatment-related adverse events (AEs) (any grade) included transient photophobia (66%), nausea (40%), fatigue (31%), decreased appetite (22%), and dysgeusia (16%). Grade ≥ 3 related AEs (N = 8) and dose-limiting toxicities (N = 1 at 96 mg dose level) were uncommon. No Grade ≥ 3 thrombocytopenia was observed. Exposure to ZEN-3694 increased with dose without significant drug-drug interaction with ENZ. PD analyses demonstrated exposure-dependent, up to 4-fold decrease in expression of BETi targets. RNA-Seq of paired tumor biopsies demonstrated suppression of BET-dependent genes. The overall median TTP was 44.4 weeks, and was similar in subgroups with prior ABI vs. ENZ resistance. Durable responses were observed, including 3 pts with disease primarily refractory to ABI on study treatment for 21.3 +, 20.8 +, and 17.3 months, respectively, with > 90% decline in serum PSA. Early transitory serum PSA increases were associated with longer TTP.
Conclusions: ZEN-3694 demonstrates an acceptable safety and PK profile, robust target modulation, and encouraging disease stabilization in combination with ENZ in ABI/ENZ-refractory mCRPC. Analysis of paired metastatic tumor biopsies, circulating tumor cells and ctDNA is ongoing. Further investigation of the combination is warranted.
Citation Format: Rahul Aggarwal, Wassim Abida, Michael Schweizer, Allan Pantuck, David Nanus, Elisabeth Heath, Sanjay Lakhotia, Henrik Hansen, Michael Silverman, Lisa Bauman, Margo Snyder, Eric Campeau, Karen Norek, Sarah Attwell, Marie O'Farrell, Steve Smith, Philip Wegge, Ravi Jahagirdar, Joshi Alumkal. A Phase Ib/IIa study of the BET bromodomain inhibitor ZEN-3694 in combination with enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT095.
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Affiliation(s)
- Rahul Aggarwal
- 1University of California San Francisco, San Francisco, CA
| | - Wassim Abida
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Allan Pantuck
- 4University of California Los Angeles, Los Angeles, CA
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Shakeri S, Afshari Mirak S, Mohammadian Bajgiran A, Pantuck A, Sisk A, Ahuja P, Lu DS, Raman SS. The effect of tumor size and location on efficacy and safety of US- and CT- guided percutaneous microwave ablation in renal cell carcinomas. Abdom Radiol (NY) 2019; 44:2308-2315. [PMID: 30847565 DOI: 10.1007/s00261-019-01967-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the effect of size and central location of the tumor on safety and efficacy of percutaneous CEUS- and CT-guided MWA in biopsy-proven renal cell carcinomas (RCCs). MATERIALS AND METHODS In this IRB-approved retrospective study, 69 biopsy-proven renal tumors in 56 patients, who underwent MWA in our institution from January 2013 to March 2017, were evaluated. Data collection included demographics, tumor characteristics, procedural protocols, and follow-up visits within 6 months post procedure. Primary outcomes were assessed by technical success (TS), local tumor progression (LTP), and complications. The Kaplan-Meier analysis was used for survival rate. RESULTS Overall technical success was achieved for all 69 lesions (92.8% primary TS, 100% overall). Median nephrometry score was 8 (4-11) and median tumor size was 2.5 cm (0.8-7). Five lesions which required second ablation had significantly higher median tumor size 4 cm (P = 0.039) with the same nephrometry score. Renal function remained stable with no significant change in eGFR before or after ablation. The LTP rate was 5.8%. The most recurrent tumors were clear cell (50%) followed by papillary tumors (25%). The complication rate was 5.8% with minor complications (hematoma and pain) and no major issues. There was no significant association between nephrometry score and technical success, recurrence, or complication rates. Overall and tumor-specific survival rates were 96.7% and 100% at 11.9 months. CONCLUSIONS Image-guided MWA appears to be a safe and effective treatment regardless of nephrometry score and tumor location with high technical success, low recurrence, and complication rates.
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Affiliation(s)
- Sepideh Shakeri
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Sohrab Afshari Mirak
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | | | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Preeti Ahuja
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David S Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Kroeger N, Li H, De Velasco G, Donskov F, Sim HW, Stühler V, Wells JC, Stukalin I, Heide J, Bedke J, Agarwal N, Parekh H, Rini BI, Knox JJ, Pantuck A, Choueiri TK, Chin Heng DY. Active Smoking Is Associated With Worse Prognosis in Metastatic Renal Cell Carcinoma Patients Treated With Targeted Therapies. Clin Genitourin Cancer 2018; 17:65-71. [PMID: 30341028 DOI: 10.1016/j.clgc.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Smoking increases the risk of developing renal cell carcinoma (RCC) but the effect of tobacco consumption on survival outcome of patients with metastatic RCC (mRCC) treated with targeted therapies has not been well characterized. PATIENTS AND METHODS The primary outcome was overall survival (OS) and secondary outcome was progression-free survival (PFS). Patients with mRCC were categorized as current, former, and nonsmokers at the time of starting targeted therapy. Smoking data from 1980 patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium (IMDC) from 12 international cancer centers. RESULTS Although former and nonsmokers had comparable OS times (23.8 vs. 23.4 months; P = .898), current smokers had significantly shorter OS (16.1 months; P < .001) than nonsmokers. Current but not former smoking status was an independent poor prognosis factor (hazard ratio [HR], 1.3; P = .002) when adjusted for the IMDC risk criteria. Each pack-year increased the risk of death by 1% (HR, 1.01; P = .036). The duration of first-line therapy response was not different and was 7.7 months versus 7.5 months versus 6.4 months in never, former (P = .609), and current smokers (P = .839), respectively. CONCLUSION Active smoking is associated with diminished OS in mRCC patients treated with targeted therapy agents. However, patients who quit smoking returned to a similar risk of death from RCC compared with patients who never smoked. Smoking cessation should be a counseling priority among mRCC patients receiving targeted agents and smoking should be considered as a confounding factor in major clinical trials.
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Affiliation(s)
- Nils Kroeger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany; Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Haoran Li
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | | | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Viktoria Stühler
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - J Connor Wells
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Igor Stukalin
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Johannes Heide
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany
| | - Jens Bedke
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Neeraj Agarwal
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Hiral Parekh
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Jennifer J Knox
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Allan Pantuck
- UCLA Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Steven A, Leisz S, Fussek S, Nowroozizadeh B, Huang J, Branstetter D, Dougall WC, Burchardt M, Belldegrun AS, Seliger B, Pantuck A, Kroeger N. Receptor activator of NF-κB (RANK)-mediated induction of metastatic spread and association with poor prognosis in renal cell carcinoma. Urol Oncol 2018; 36:502.e15-502.e24. [PMID: 30170981 DOI: 10.1016/j.urolonc.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inhibition of the receptor activator of NF-κB ligand (RANKL) has become a standard of care supportive treatment to prevent skeletal related events in cancer patients. Moreover, RANKL inhibition has been implicated with better survival outcome in lung cancer, while RANKL expression induces tumor progression and metastatic spread in vivo in breast cancer. Whether RANK/RANKL may have an impact on the pathogenesis of clear cell renal cell carcinoma (ccRCC) is currently unknown. PATIENTS AND METHODS A retrospective tissue micro array (TMA)-study was carried out determining the expression of RANK/RANKL in primary tumors of 306 ccRCC patients. Additionally, 24 ccRCC cell lines were employed for in vitro analyses of the RANK/RANKL axis including cell proliferation, migration and anchorage independent growth. RESULTS RANK (+) vs. RANK (-) tumors had both worse cancer specific survival (CSS) (6.3 vs. 1.3 years; p < 0.001) and recurrence free survival (RFS) (9.9 vs. 5.8 years; p < 0.001). RANK (+) (HR 2.21; p < 0.001) was an independent prognostic factor for CSS and RFS (HR 4.98; p < 0.001). RANKL treatment resulted in increased proliferation, soft agar growth, and colony formation of RANK (+) RCC cell lines, which could be reversed by treatment with an NF-κB inhibitor and with a combination of osteoprotegrin and RANKL in vitro. CONCLUSIONS RANK is expressed in ccRCC tissue, correlates with clinicopathological features, survival outcome, and when stimulated with RANKL can induce ccRCC progression in vitro. Consequently, RANKL inhibition combined with standard of care treatment may be a promising approach to improve ccRCC patient's survival.
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Affiliation(s)
- André Steven
- Institute of Medical Immunology at the Martin Luther University Halle/Wittenberg, Halle, Germany
| | - Sandra Leisz
- Institute of Medical Immunology at the Martin Luther University Halle/Wittenberg, Halle, Germany
| | - Sebastian Fussek
- Department of Urology, University Medicine at the Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Behdokht Nowroozizadeh
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Jiaoti Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | | | - William C Dougall
- Department of Hematology and Oncology Research, Amgen Inc., Seattle, WA
| | - Martin Burchardt
- Department of Urology, University Medicine at the Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arie S Belldegrun
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Barbara Seliger
- Institute of Medical Immunology at the Martin Luther University Halle/Wittenberg, Halle, Germany
| | - Allan Pantuck
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Nils Kroeger
- Department of Urology, University Medicine at the Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany; Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA; Institute of Medical Biochemistry and Molecular Medicine, University Medicine at the Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.
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Alle N, Tan N, Huss J, Huang J, Pantuck A, Raman SS. Percutaneous image-guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation, and clinical significance. Abdom Radiol (NY) 2018; 43:1813-1819. [PMID: 29079986 DOI: 10.1007/s00261-017-1337-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the efficacy, safety and clinical utility of CT and US-guided percutaneous renal mass biopsy. MATERIALS AND METHODS A retrospective IRB-approved, HIPAA-compliant study of a cohort of 183 consecutive patients who underwent percutaneous, CT or US-guided renal mass biopsy (RMB) from March 2002 through December 2012 was performed. RMB was performed in 183 consecutive patients for suspected solid renal mass of whom 14/183 (7.7%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Ten patients had multiple biopsies for new growing masses. Using US, CT or CT/US fusion-guidance, a 17G or 19G cannula needle was placed at the margin of the mass and an 18G or 20G core biopsy gun was used to obtain several tissue cores. Renal parenchymal biopsies for medical renal diseases were excluded. Imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, immunohistochemical (IHC) studies, and subsequent final pathological diagnosis on nephrectomy were evaluated. RESULTS Of the 169 patients with 184 RMB, 121/169 (71.6%) were male with a mean age of 67.5 years. Of 184 RMB, 126 were malignant [126/184 (68.5%)], 37 [37/184 (20.1%)], were benign, and 21 (21/184 (11.4%) were nondiagnostic. IHC was performed in 131 biopsies (71.1%) and was diagnostic in 88.5% of those cases. Twenty-eight patients underwent subsequent partial nephrectomy; in 27/27 (100%) cases, RMB was concordant with nephrectomy for malignancy and in 21/27 (77.8%) RMB was concordant for subtype of RCC. Overall, the RMB sensitivity for detection of malignancy, specificity, and positive predictive value were 100%. The negative predictive value of benign RMB diagnosis was also 100%. There was a total of 14 (7.6%) complications, 13 minor (7.1%) and 1 major (0.5%). Of the minor complications, ten (5.5%) were postprocedural minor hematomas that resolved conservatively; one (0.5%) postprocedural vasovagal reaction; one (0.5%) episode of hematuria; and one (0.5%) episode of nausea and abdominal discomfort. No cases of renal pseudoaneurysm or tumor seeding attributed to biopsy were identified. CONCLUSION Percutaneous image-guided RMB is safe and highly diagnostic when combined with IHC and supports a greater role of RMB and imaging in evaluating renal masses when rendering appropriate treatments.
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Affiliation(s)
- Nisha Alle
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, 90095-7437, USA.
| | - Nelly Tan
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie Huss
- The Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiatoi Huang
- The Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Allan Pantuck
- The Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- The Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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McClure T, Pantuck A, Sayer J, Raman S. Efficacy of percutaneous radiofrequency ablation may vary with clear cell renal cell cancer histologic subtype. Abdom Radiol (NY) 2018; 43:1472-1477. [PMID: 28936542 DOI: 10.1007/s00261-017-1322-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of the study is to determine if clear cell renal cell cancer (RCC) subtype predicts efficacy in percutaneous radiofrequency (RF) ablation of RCC. METHODS AND MATERIALS Patients who underwent percutaneous RF ablation for histologically proven RCC subtypes were retrospectively reviewed. Group comparisons were done using univariate and multivariate logistic regression analysis to determine factors impacting primary, secondary, and total technique effectiveness. A p value less than 0.05 was considered significant. RESULTS One hundred pathologically proven RCC lesions in 84 patients were analyzed. The median (mean) follow-up was 24 (27) months (range 1-106 months). Overall RF ablation primary, secondary and total technique effectiveness was 86%, 9%, and 95%, respectively. Clear cell subtype demonstrated worse treatment efficacy with primary, secondary, and total technique effectiveness of 42/55 (76.4%), 8/55 (14.5%), and 50/55 (90.9%), respectively. Non-clear cell subtypes had primary, secondary, and total technique effectiveness of 44/45(97.8%), 1/45 (2.2%), 45/45 (100%), respectively. The difference in primary (p = 0.002), secondary (p = 0.032), and total (p = 0.038) technique effectiveness between the two groups was statistically significant. CONCLUSION Clear cell RCC was a novel predictor of primary, secondary, and total technique efficacy in the percutaneous RF ablation of clear cell RCC.
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Affiliation(s)
- Timothy McClure
- Department of Radiology, University of California, Los Angeles, USA.
- Department of Urology and Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr 946, New York, NY, 10065, USA.
| | - Allan Pantuck
- Department of Urology, University of California, Los Angeles, USA
| | - James Sayer
- Department of Radiology, University of California, Los Angeles, USA
| | - Steven Raman
- Department of Radiology, University of California, Los Angeles, USA
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13
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Shakeri S, Afshari Mirak S, Pantuck A, Sisk A, Ahuja P, Lu D, Raman S. PD61-10 SAFETY AND EFFICACY OF PERCUTANEOUS US AND CT GUIDED MICROWAVE ABLATION OF T1A AND T1B RENAL TUMORS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Lenis A, Burton C, Faiena I, Salmasi A, Pooli A, Johnson D, Drakaki A, Gollapudi K, Blumberg J, Pantuck A, Chamie K. MP28-09 CYTOREDUCTIVE NEPHRECTOMY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA AND TUMOR THROMBUS – TRENDS AND EFFECT ON OVERALL SURVIVAL. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Elkhoury F, Natarajan S, Priester A, Jones T, Geoghegan R, Delfin M, Felker E, Sisk A, Raman S, Pantuck A, Grundfest W, Marks L. MP30-04 MRI-GUIDED BIOPSY FOLLOWING FOCAL LASER ABLATION OF PROSTATE CANCER: SUBSEQUENT OUTCOMES OF 2 CLINICAL TRIALS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Jones TA, Chin J, Mcleod D, Barkin J, Pantuck A, Marks LS. High Intensity Focused Ultrasound for Radiorecurrent Prostate Cancer: A North American Clinical Trial. J Urol 2018; 199:133-139. [DOI: 10.1016/j.juro.2017.06.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Tonye A. Jones
- Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Joseph Chin
- Division of Urology, London Health Sciences Center, Toronto, Ontario, Canada
| | - David Mcleod
- Department of Surgery, Center for Prostate Cancer Disease Research, Uniformed Services University of the Health Sciences and Walter Reed National Medical Military Center, Bethesda, Maryland
| | | | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
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17
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Davis ID, Xie W, Pezaro C, Donskov F, Wells JC, Agarwal N, Srinivas S, Yuasa T, Beuselinck B, Wood LA, Ernst DS, Kanesvaran R, Knox JJ, Pantuck A, Saleem S, Alva A, Rini BI, Lee JL, Choueiri TK, Heng DY. Efficacy of Second-line Targeted Therapy for Renal Cell Carcinoma According to Change from Baseline in International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Category. Eur Urol 2017; 71:970-978. [DOI: 10.1016/j.eururo.2016.09.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
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18
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Lenis AT, Donin NM, Johnson DC, Faiena I, Salmasi A, Drakaki A, Belldegrun A, Pantuck A, Chamie K. Adjuvant Therapy for High Risk Localized Kidney Cancer: Emerging Evidence and Future Clinical Trials. J Urol 2017; 199:43-52. [PMID: 28479237 DOI: 10.1016/j.juro.2017.04.092] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE We reviewed the literature on adjuvant therapies for patients with high risk localized kidney cancer following surgical resection. In this analysis we merge 2 recently published prospective trials with conflicting results within the context of their respective designs. In addition, we spotlight upcoming trials that use novel immunotherapy based checkpoint inhibitors and have the potential to establish a new standard of care. MATERIALS AND METHODS We searched PubMed® for English language articles published through January 2017 using the keywords "renal cell carcinoma," "kidney cancer," "immunotherapy," "targeted therapy" and "adjuvant therapy." ClinicalTrials.gov was queried for ongoing studies. Relevant data recently presented at major urology and medical oncology meetings are also included. RESULTS Adjuvant therapies for high risk localized kidney cancer can be grouped into the categories of 1) traditional immunotherapy, 2) inhibitors of the vascular endothelial growth factor and mTOR (mammalian target of rapamycin) pathways, 3) vaccines and antibody dependent cytotoxic agents, and 4) immune checkpoint inhibitors. Several trials of traditional immunotherapy, such as interferon-α and high dose interleukin-2, failed to demonstrate benefit as adjuvant treatment and were associated with significant adverse events. Vascular endothelial growth factor and mTOR inhibitors have less severe toxicity in metastatic disease and, therefore, are natural considerations for adjuvant trials. However, current data are conflicting. The ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients with Kidney Cancer that was Removed by Surgery, NCT00326898) trial found no recurrence-free survival benefit of sorafenib or sunitinib over placebo, while S-TRAC (Clinical Trial Comparing Efficacy and Safety of Sunitinib versus Placebo for the Treatment of Patients at High Risk of Recurrent Renal Cell Cancer, NCT00375674) revealed that 1 year of sunitinib improved recurrence-free survival by 1.2 years. Vaccine based treatments and antibody dependent cytotoxic agents have had mixed results. New trials evaluating immune checkpoint inhibitors are planned, given the impressive efficacy and tolerability as second line agents in metastatic disease. Future adjuvant trials are likely to be guided by molecular signatures to treat patients most likely to benefit. CONCLUSIONS Based on the available data, there appears to be no role for traditional immunotherapy as adjuvant treatment in patients with high risk localized kidney cancer following surgical resection. S-TRAC provides evidence that 1 year of adjuvant sunitinib in patients with higher risk locoregional disease increases the median time to recurrence. However, the data on overall survival are immature and adverse effects are common. Results from trials investigating immune checkpoint inhibitors are highly anticipated.
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Affiliation(s)
- Andrew T Lenis
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Nicholas M Donin
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - David C Johnson
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Izak Faiena
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Amirali Salmasi
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Alexandra Drakaki
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arie Belldegrun
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Karim Chamie
- Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.
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Natarajan S, Jones TA, Priester AM, Geoghegan R, Lieu P, Delfin M, Felker E, Margolis DJA, Sisk A, Pantuck A, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance. J Urol 2017; 198:839-847. [PMID: 28396184 DOI: 10.1016/j.juro.2017.04.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Tonye A Jones
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Rory Geoghegan
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Ely Felker
- Department of Radiology, University of California-Los Angeles, Los Angeles, California
| | | | - Anthony Sisk
- Department of Pathology, University of California-Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California.
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Salmasi A, Lenis A, Faiena I, Donin N, Pantuck A, Chamie K. PD73-01 RENAL MASS BIOPSY IS ASSOCIATED WITH INCREASED INCIDENCE OF PATHOLOGICAL UPSTAGING TO PERINEPHRIC FAT INVASION IN PATIENTS WITH CLINICALLY LOCALIZED RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Pantuck A, Patard JJ, Patel A, Ravaud A, Motzer RJ, Pandha HS, George DJ, Chang YH, Escudier B, Donskov F, Magheli A, Carteni G, Laguerre B, Tomczak P, Breza J, Gerletti P, Lechuga M, Lin X, Casey M, Staehler M. PD04-02 ADJUVANT SUNITINIB IN PATIENTS WITH HIGH RISK RENAL CELL CARCINOMA: SUBGROUP ANALYSES FROM S-TRAC TRIAL. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan Breza
- Bratislava, Slovakia(Slovak Republic)
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22
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Patel S, Demanes DJ, Ragab O, Zhang M, Veruttipong D, Nguyen K, Park SJ, Marks L, Pantuck A, Steinberg M, Kamrava M. High-dose-rate brachytherapy monotherapy without androgen deprivation therapy for intermediate-risk prostate cancer. Brachytherapy 2017; 16:299-305. [DOI: 10.1016/j.brachy.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/22/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
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Donin NM, Duarte S, Lenis AT, Caliliw R, Torres C, Smithson A, Strauss-Ayali D, Agmon-Gerstein Y, Malchi N, Said J, Raman SS, Holden S, Pantuck A, Belldegrun AS, Chamie K. Sustained-release Formulation of Mitomycin C to the Upper Urinary Tract Using a Thermosensitive Polymer: A Preclinical Study. Urology 2016; 99:270-277. [PMID: 27720772 DOI: 10.1016/j.urology.2016.09.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/22/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the safety and feasibility of single and serial instillations of MitoGel into the upper urinary tract using a preclinical swine animal model. MitoGel is a novel sustained release formulation of mitomycin C (MMC) based on RTGel, a proprietary thermosensitive hydrogel technology. MitoGel is liquid at cold temperatures and solidifies to gel state at body temperature. It is intended as a treatment for upper tract urothelial carcinoma, given its ability to provide sustained release of MMC in the upper urinary tract. MATERIALS AND METHODS We utilized 23 pigs in a 3-phase design. All animals underwent bilateral nephrostomy tube placement. During phase 1, 3 animals underwent antegrade RTGel instillation, imaging, and euthanasia within 12 hours. In phase 2, 10 pigs underwent single antegrade instillation, unilateral nephrectomy 3 days following instillation, and contralateral nephrectomy and euthanasia 30 days following instillation. During phase 3, 10 animals underwent 6 instillations over 3 weeks, followed by bilateral nephrectomy and necropsy 30 days postinstillation. MitoGel (2 mg/mL and 4 mg/mL), aqueous MMC (2 mg/mL and 4 mg/mL), and RTGel alone were evaluated. RESULTS MitoGel remained visible within the pelvicalyceal system on fluoroscopic and computed tomography imaging for 4-6 hours. MMC plasma levels were well within acceptable safety thresholds. There was no evidence of urinary obstruction, acute kidney injury, sepsis, or myelosuppression. Histologic changes in the urinary system were mild and transient. CONCLUSION Antegrade MitoGel delivery to the pelvicalyceal system of Yorkshire swine is feasible and safe. Further evaluation of MitoGel in human clinical trials is warranted.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Sandra Duarte
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Andrew T Lenis
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Randy Caliliw
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Cristobal Torres
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Anthony Smithson
- Division of Laboratory and Animal Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Jonathan Said
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Stuart Holden
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
| | - Arie S Belldegrun
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
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Donin NM, Lenis AT, Holden S, Drakaki A, Pantuck A, Belldegrun A, Chamie K. Immunotherapy for the Treatment of Urothelial Carcinoma. J Urol 2016; 197:14-22. [PMID: 27460757 DOI: 10.1016/j.juro.2016.02.3005] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE We review the biological mechanisms of action, clinical safety and efficacy of immunotherapies for urothelial carcinoma. We also describe current areas of research in immunotherapy, and highlight ongoing trials and promising and novel investigational agents. MATERIALS AND METHODS Data were obtained by a search of PubMed®, ClinicalTrials.gov and Cochrane databases for English language articles published through February 2016. Applicable abstracts from recent Society of Urologic Oncology, European Association of Urology, American Urological Association and ASCO® meetings were used. RESULTS Bacillus Calmette-Guérin is one of the most successful immunotherapies in cancer treatment and remains the gold standard of care for patients with high risk, nonmuscle invasive bladder cancer, with initial response rates of approximately 70%. However, with the exception of valrubicin and standard chemotherapeutics there is a paucity of available treatment options for patients with recurrence or progression to more advanced disease. Recently there has been significant interest in novel immunotherapeutic agents in the management of cases where bacillus Calmette-Guérin fails, as well as cases of more advanced cancer. These investigational therapies can generally be classified into several broad categories, including recombinant bacillus Calmette-Guérin and cell wall derived therapies, cytokines, gene therapy, cancer vaccines, immune checkpoint inhibitors, oncolytic viruses, adoptive immunotherapies and immune agonists, as well as several additional immunomodulatory agents. The majority of these agents are currently under investigation in phase I or II clinical trials. Recently investigators reported evidence that inhibition of the PD-1/PD-L1 pathway has clinical activity in patients with advanced bladder cancer. These findings, along with successful phase III trials and U.S. Food and Drug Administration approvals of other checkpoint inhibitors in melanoma, nonsmall cell lung cancer and renal cell carcinoma, ultimately led to Food and Drug Administration approval of atezolizumab for advanced disease, the first new treatment approved for advanced urothelial carcinoma in 20 years. CONCLUSIONS While bacillus Calmette-Guérin has demonstrated significant clinical efficacy in the treatment of patients with bladder cancer, additional therapies are needed for those in whom bacillus Calmette-Guérin fails, as well as for those with advanced disease. Immunotherapy for urothelial carcinoma remains a promising and active area of research, and numerous agents, particularly the monoclonal antibodies targeting checkpoint inhibition pathways, are showing encouraging signs of clinical activity.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Andrew T Lenis
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Stuart Holden
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Alexandra Drakaki
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Allan Pantuck
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Arie Belldegrun
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California
| | - Karim Chamie
- Department of Urology, Institute of Urologic Oncology (NMD, SH, AD, AP, AB, KC), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Division of Hematology and Oncology (AD), David Geffen School of Medicine at UCLA, Los Angeles, California; Jonsson Comprehensive Cancer Center (AD, AP, AB, KC), University of California, Los Angeles, California.
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Donin NM, Pantuck A, Klöpfer P, Bevan P, Fall B, Said J, Belldegrun AS, Chamie K. Body Mass Index and Survival in a Prospective Randomized Trial of Localized High-Risk Renal Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25:1326-32. [DOI: 10.1158/1055-9965.epi-16-0226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022] Open
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Donin N, Duarte S, Strauss-Ayali D, Agmon-Gerstein Y, Malchi N, Pantuck A, Belldegrun A, Chamie K. PD13-10 PRECLINICAL TRIAL OF SERIAL MITOGEL® INSTILLATIONS INTO THE PELVICALYCEAL SYSTEM OF THE YORKSHIRE SWINE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laviana A, Salmasi A, Hu J, Kuo M, Rathmell W, Belldegrun A, Pantuck A. MP71-02 UTILITY OF CLEAR CELL RENAL CELL CARCINOMA GENE EXPRESSION SUBTYPES IN RISK-STRATIFYING T1 RENAL MASSES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bi M, Zhao S, Merino M, Said J, Adeniran A, Nawaf C, Xie Z, Boeke M, Valera V, Pantuck A, Belldegrun A, Kluger H, Lifton R, Shuch B. MP71-12 GENOMIC CHARACTERIZATION OF SARCOMATOID TRANSFORMATION IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miles FL, Rao JY, Eckhert C, Chang SC, Pantuck A, Zhang ZF. Associations of immunity-related single nucleotide polymorphisms with overall survival among prostate cancer patients. Int J Clin Exp Med 2015; 8:11470-11476. [PMID: 26379965 PMCID: PMC4565348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/24/2015] [Indexed: 06/05/2023]
Abstract
The progression of prostate cancer is influenced by systemic inflammation, and may be attributed, in part, to genetic predisposition. Single nucleotide polymorphisms associated with the immune response may help mediate prostate cancer progression. We analyzed data from a hospital-based case-control study of 164 prostate cancer patients and 157 healthy male controls from the Memorial Sloan Kettering Cancer Center. We evaluated associations between six immunity-related polymorphisms (CRP rs1205 and rs1800947, FGFR2 rs1219648 and rs2981582, IFNGR1 rs11914, and IL10 rs1800871) and overall survival among prostate cancer patients, calculating adjusted hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression. FGFR2 rs1219648 (GG vs. AA) and rs2981582 (TT vs. CC) polymorphisms were associated with more favorable overall survival (HR: 0.13, 95% CI: 0.03-0.62 and HR: 0.13, 95% CI: 0.03-0.53, respectively) in patients with primary prostate cancer. These observations highlight the need to validate and identify these and other immunity-related polymorphisms in larger studies examining survival of prostate cancer patients.
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Affiliation(s)
- Fayth L Miles
- Department of Epidemiology, Fielding School of Public Health, University of California-Los AngelesLos Angeles, CA, USA
| | - Jian-Yu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLALos Angeles, CA, USA
| | - Curtis Eckhert
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California-Los AngelesLos Angeles, CA, USA
| | - Shen-Chih Chang
- Department of Epidemiology, Fielding School of Public Health, University of California-Los AngelesLos Angeles, CA, USA
| | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLALos Angeles, CA, USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California-Los AngelesLos Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California-Los AngelesLos Angeles, CA, USA
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Casuscelli J, Lee W, Wang P, Russo P, Coleman JA, Pantuck A, Thompson RH, Reuter VE, Hakimi AA, Hsieh JJ. MP47-14 MUTATION ANALYSIS OF AGGRESSIVE CHROMOPHOBE RENAL CELL CANCER PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McClure T, Pantuck A, Sayre J, Raman S. MP57-19 NOVEL PREDICTORS OF EFFICACY IN PERCUTANEOUS RADIOFREQUENCY ABLATION OF RENAL CELL CARCINOMA: R.E.N.A.L. NEPHROMETRY SCORE AND RENAL CELL CARCINOMA SUBTYPE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kroeger N, Kapur P, Huang J, Belldegrun A, Brugarolas J, Pantuck A. MP47-06 BRCA1 ASSOCIATED PROTEIN-1 (BAP-1) LOSS IN CCRCC: MOLECULAR CORRELATIONS AND VALIDATION AS A PROGNOSTIC FACTOR. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pouliot F, Pantuck A, Imbeault A, Shuch B, Calimlim B, Audet JF, Finley DS, Dujardin T. Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Partial nephrectomy (PN) is now the gold standardfor the surgical treatment of small renal masses. We evaluated theeffect of WIT and other factors on RDF assessed by preoperativeand postoperative renal scintigraphy.Methods: Between 2003 and 2008, 182 consecutive laparoscopicPN (LPN) were performed in an academic centre. Among those,56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphypreoperatively and postoperatively.Results: Medians for age, preoperative estimated glomerular filtrationrate and computed tomography scan tumour size were 62years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WITand preoperative RDF were 30 minutes and 50%, respectively.Median loss of RDF after surgery was 14%. Linear regression curvesshowed that loss in RDF rate was 0.2% per minute when WIT was<30 minutes and 0.7% per minute when WIT was ≥30 minutes.In multivariate analysis, length of WIT and endophytic tumourlocation were associated with a statistically significant loss of RDF(p < 0.05), but only in the group who experienced >30 minutesof WIT.Interpretation: Our results suggest that the factors associated withloss of RDF are not the same before and after 30 minutes of WITand that the rate of loss in RDF increases after 30 minutes. Since,the effect of WIT is small up to 30 minutes, we believe that surgeryshould focus on limiting the resection of normal parenchymaand to ensure negative margins and hemostasis, rather than onpremature unclamping.
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Kroeger N, Seligson D, Signoretti S, Yu H, Logan J, Birkhäuser F, Magyar C, Huang J, Riss J, Kabbinavar F, Belldegrun A, Pantuck A. 1071 POOR PROGNOSIS AND ADVANCED CLINICOPATHOLOGICAL FEATURES OF CLEAR CELL RENAL CELL CARCINOMA (CCRCC) ARE ASSOCIATED WITH CYTOPLASMIC SUBCELLULAR LOCALIZATION OF HIF-2α. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, Fizazi K, Mainwaring P, Piulats JM, Ng S, Carles J, Mulders PFA, Basch E, Small EJ, Saad F, Schrijvers D, Van Poppel H, Mukherjee SD, Suttmann H, Gerritsen WR, Flaig TW, George DJ, Yu EY, Efstathiou E, Pantuck A, Winquist E, Higano CS, Taplin ME, Park Y, Kheoh T, Griffin T, Scher HI, Rathkopf DE. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 2013; 368:138-48. [PMID: 23228172 PMCID: PMC3683570 DOI: 10.1056/nejmoa1209096] [Citation(s) in RCA: 2020] [Impact Index Per Article: 183.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abiraterone acetate, an androgen biosynthesis inhibitor, improves overall survival in patients with metastatic castration-resistant prostate cancer after chemotherapy. We evaluated this agent in patients who had not received previous chemotherapy. METHODS In this double-blind study, we randomly assigned 1088 patients to receive abiraterone acetate (1000 mg) plus prednisone (5 mg twice daily) or placebo plus prednisone. The coprimary end points were radiographic progression-free survival and overall survival. RESULTS The study was unblinded after a planned interim analysis that was performed after 43% of the expected deaths had occurred. The median radiographic progression-free survival was 16.5 months with abiraterone-prednisone and 8.3 months with prednisone alone (hazard ratio for abiraterone-prednisone vs. prednisone alone, 0.53; 95% confidence interval [CI], 0.45 to 0.62; P<0.001). Over a median follow-up period of 22.2 months, overall survival was improved with abiraterone-prednisone (median not reached, vs. 27.2 months for prednisone alone; hazard ratio, 0.75; 95% CI, 0.61 to 0.93; P=0.01) but did not cross the efficacy boundary. Abiraterone-prednisone showed superiority over prednisone alone with respect to time to initiation of cytotoxic chemotherapy, opiate use for cancer-related pain, prostate-specific antigen progression, and decline in performance status. Grade 3 or 4 mineralocorticoid-related adverse events and abnormalities on liver-function testing were more common with abiraterone-prednisone. CONCLUSIONS Abiraterone improved radiographic progression-free survival, showed a trend toward improved overall survival, and significantly delayed clinical decline and initiation of chemotherapy in patients with metastatic castration-resistant prostate cancer. (Funded by Janssen Research and Development, formerly Cougar Biotechnology; ClinicalTrials.gov number, NCT00887198.).
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Affiliation(s)
- Charles J Ryan
- Genitourinary Medical Oncology Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94115, USA.
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Heesakkers J, Farag F, Pantuck A, Moore K, Radziszewski P, Lucas M. Applicability of a disposable home urinary flow measuring device as a diagnostic tool in the management of males with lower urinary tract symptoms. Urol Int 2012; 89:166-72. [PMID: 22797567 DOI: 10.1159/000338907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/14/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To investigate the accuracy of uroflowmetry with disposable Q(Single) compared to measurements with a home-based digital device and compared to a single clinical measurement. PATIENTS AND METHODS 60 men with lower urinary tract symptoms were included in a prospective, open-label, multicenter study. Uroflowmetry measurements were done using three devices/methods: single clinic-based method, followed by up to 12 measurements using the disposable home-based Q(Single) and up to 12 measurements using a home-based digital device. Subjective data on ease of use of Q(Single) and preference of patients was investigated and objective measures of Q(max) and voided volume from the three devices were compared. RESULTS Mean Q(max) values of 12, 13 and 16 ml/s were achieved with the Q(Single) device, standard clinic method, and digital device, respectively. Mean Q(max) obtained with the Q(Single) device did not differ from that obtained with the clinic method. A significantly higher mean Q(max) was recorded for the digital device. Mean voided volumes recorded with each device differed marginally. Handling capabilities of the Q(Single) device were considered good by all subjects. CONCLUSIONS The accuracy of Q(max) and voided volume mean measurements with Q(Single) was comparable to one standard clinic recording. Q(Single) offers a viable alternative to reduce the number of clinic visits and can be used by other caregivers.
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Affiliation(s)
- John Heesakkers
- Department of Urology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
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Mueller ER, Kenton K, Tarnay C, Brubaker L, Rosenman A, Smith B, Stroupe K, Bresee C, Pantuck A, Schulam P, Anger JT. Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS). Contemp Clin Trials 2012; 33:1011-8. [PMID: 22643040 DOI: 10.1016/j.cct.2012.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/03/2012] [Accepted: 05/19/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Robotic assistance during laparoscopic surgery for pelvic organ prolapse rapidly disseminated across the United States without level I data to support its benefit over traditional open and laparoscopic approaches [1]. This manuscript describes design and methodology of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS) Trial. METHODS ACCESS is a randomized comparative effectiveness trial enrolling patients at two academic teaching facilities, UCLA (Los Angeles, CA) and Loyola University (Chicago, IL). The primary aim is to compare costs of robotic assisted versus pure laparoscopic abdominal sacrocolpopexy (RASC vs LASC). Following a clinical decision for minimally-invasive abdominal sacrocolpopexy (ASC) and research consent, participants with symptomatic stage≥II pelvic organ prolapse are randomized to LASC or RASC on the day of surgery. Costs of care are based on each patient's billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot and initial hospitalization and any re-hospitalization in the first 6weeks are compared between groups. Secondary outcomes include post-operative pain, anatomic outcomes, symptom severity and quality of life, and adverse events. Power calculation determined that 32 women in each arm would provide 95% power to detect a $2500 difference in total charges, using a two-sided two sample t-test with a significance level of 0.05. RESULTS Enrollment was completed in May 2011. The 12-month follow-up was completed in May 2012. CONCLUSIONS This is a multi-center study to assess cost as a primary outcome in a comparative effectiveness trial of LASC versus RASC.
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Affiliation(s)
- E R Mueller
- Department of Obstetrics/Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153 USA.
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Klatte T, Kroeger N, Rampersaud E, Birkhaeuser F, Logan J, Sonn G, Riss J, Rao PN, Kabbinavar F, Belldegrun A, Pantuck A. 437 GAIN OF CHROMOSOME 8Q IS ASSOCIATED WITH METASTASES AND POOR SURVIVAL OF PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Freedland S, Carducci M, Kroeger N, Partin A, Rao JY, Jin Y, Kerkoutian S, Wu H, Li Y, Creel P, Mundy K, Gurganus R, Fedor H, King S, Heber D, Zhang Y, Pantuck A. 174 A PHASE II RANDOMIZED CONTROLLED TRIAL OF POMX VS. PLACEBO PRIOR TO RADICAL PROSTATECTOMY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kroeger N, Seligson D, Klatte T, Rampersaud E, Birkhäuser F, Rao N, Leppert J, Zomorodian N, Kabbinavar F, Belldegrun A, Pantuck A. 572 CLINICAL, MOLECULAR AND GENETIC CORRELATES OF LYMPHATIC SPREAD IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hanwei Z, Wang X, Seligson D, Pantuck A, Chin A. 1074 FOXP3 EXPRESSION CORRELATES WITH SURVIVAL IN UROTHELIAL CARCINOMA OF THE BLADDER. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Alle N, Tan N, Raman S, Huss J, Huang J, Pantuck A. Abstract No. 73: Percutaneous image guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation and clinical significance. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pouliot F, Pantuck A, Imbeault A, Shuch B, Calimlim B, Audet JF, Finley DS, Dujardin T. Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Can Urol Assoc J 2011; 5:89-95. [PMID: 21470531 DOI: 10.5489/cuaj.10044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) is now the gold standard for the surgical treatment of small renal masses. We evaluated the effect of WIT and other factors on RDF assessed by preoperative and postoperative renal scintigraphy. METHODS Between 2003 and 2008, 182 consecutive laparoscopic PN (LPN) were performed in an academic centre. Among those, 56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy preoperatively and postoperatively. RESULTS Medians for age, preoperative estimated glomerular filtration rate and computed tomography scan tumour size were 62 years, 82 mL/min/1.73m(2) and 26 mm, respectively. Median WIT and preoperative RDF were 30 minutes and 50%, respectively. Median loss of RDF after surgery was 14%. Linear regression curves showed that loss in RDF rate was 0.2% per minute when WIT was <30 minutes and 0.7% per minute when WIT was ≥30 minutes. In multivariate analysis, length of WIT and endophytic tumour location were associated with a statistically significant loss of RDF (p < 0.05), but only in the group who experienced >30 minutes of WIT. INTERPRETATION Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.
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Affiliation(s)
- Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC; Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA Dr. Pouliot was supported in part by a scholarship from Les Bourses McLaughlin du Doyen, a scholarship from the Association des Urologues du Québec and a scholarship from the CMDP (Committee of physicians, dentists and pharmacists) of the Laval University Hospital Centre
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Rampersaud E, Klatte T, Pouliot F, Li D, Anterasian C, Zomorodian N, Kabbinavar F, Miller D, Belldegrun A, Pantuck A. 1770 CANCER-SPECIFIC SURVIVAL OUTCOMES OF SUNITINIB TREATMENT IN UISS RISK-STRATIFIED METASTATIC RCC PATIENTS. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Finley DS, Pouliot F, Pantuck A. Words of wisdom. Re: Overall survival analysis of a phase II randomized controlled trial of a poxviral-based PSA-targeted immunotherapy in metastatic castration-resistant prostate cancer. Kantoff PW, Schuetz TJ, Blumenstein BA, et al. Eur Urol 2011; 58:466. [PMID: 20845530 DOI: 10.1016/j.eururo.2010.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David S Finley
- David Geffen School of Medicine at UCLA, 650 Charles Young Drive, Box 951738 Los Angeles, CA 90095-1738, USA
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Oh SS, Chang SC, Cai L, Cordon-Cardo C, Ding BG, Greenland S, He N, Jiang Q, Kheifets L, Le A, Lee YCA, Liu S, Lu ML, Mao JT, Morgenstern H, Mu LN, Pantuck A, Papp JC, Park SL, Rao JY, Reuter VE, Tashkin DP, Wang H, You NCY, Yu SZ, Zhao JK, Belldegrun A, Zhang ZF. Single nucleotide polymorphisms of 8 inflammation-related genes and their associations with smoking-related cancers. Int J Cancer 2010; 127:2169-82. [PMID: 20112337 DOI: 10.1002/ijc.25214] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Tobacco smoke and its metabolites are carcinogens that increase tissue oxidative stress and induce target tissue inflammation. We hypothesized that genetic variation of inflammatory pathway genes plays a role in tobacco-related carcinogenesis and is modified by tobacco smoking. We evaluated the association of 12 single nucleotide polymorphisms of 8 inflammation-related genes with tobacco-related cancers (lung, oropharynx, larynx, esophagus, stomach, liver, bladder, and kidney) using 3 case-control studies from: Los Angeles (population-based; 611 lung and 553 upper aero-digestive tract cancer cases and 1,040 controls), Taixing, China (population-based; 218 esophagus, 206 stomach, 204 liver cancer cases, and 415 controls), and Memorial Sloan-Kettering Cancer Center (hospital-based; 227 bladder cancer cases and 211 controls). After adjusting for age, education, ethnicity, gender, and tobacco smoking, IL10 rs1800871 was inversely associated with oropharyngeal cancer (CT+TT vs. CC adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.50-0.95), and was positively associated with lung cancer among never smokers (TT vs. CT+CC aOR: 2.5, 95% CI: 1.3-5.1) and inversely with oropharyngeal cancer among ever smokers (CT+TT vs. CC aOR: 0.63, 95% CI: 0.41-0.95). Among all pooled never smokers (588 cases and 816 controls), TNF rs1799964 was inversely associated with smoking-related cancer (CC vs. CT+TT aOR: 0.36, 95% CI: 0.17-0.77). Bayesian correction for multiple comparisons suggests that chance is unlikely to explain our findings (although epigenetic mechanisms may be in effect), which support our hypotheses, suggesting that IL10 rs1800871 is a susceptibility marker for oropharyngeal and lung cancers, and that TNF rs1799964 is associated with smoking-related cancers among never smokers.
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Affiliation(s)
- Sam S Oh
- Department of Epidemiology, University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, CA, USA
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Pouliot F, Shuch B, LaRochelle JC, Pantuck A, Belldegrun AS. Contemporary Management of Renal Tumors With Venous Tumor Thrombus. J Urol 2010; 184:833-41; quiz 1235. [DOI: 10.1016/j.juro.2010.04.071] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Frédéric Pouliot
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brian Shuch
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey C. LaRochelle
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Park SL, Bastani D, Goldstein BY, Chang SC, Cozen W, Cai L, Cordon-Cardo C, Ding B, Greenland S, He N, Hussain SK, Jiang Q, Lee YCA, Liu S, Lu ML, Mack TM, Mao JT, Morgenstern H, Mu LN, Oh SS, Pantuck A, Papp JC, Rao J, Reuter VE, Tashkin DP, Wang H, You NCY, Yu SZ, Zhao JK, Zhang ZF. Associations between NBS1 polymorphisms, haplotypes and smoking-related cancers. Carcinogenesis 2010; 31:1264-71. [PMID: 20478923 DOI: 10.1093/carcin/bgq096] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Constituents of tobacco smoke can cause DNA double-strand breaks (DSBs), leading to tumorigenesis. The NBS1 gene product is a vital component in DSB detection and repair, thus genetic variations may influence cancer development. We examined the associations between NBS1 polymorphisms and haplotypes and newly incident smoking-related cancers in three case-control studies (Los Angeles: 611 lung and 601 upper aero-digestive tract (UADT) cancer cases and 1040 controls; Memorial Sloan-Kettering Cancer Center: 227 bladder cancer cases and 211 controls and Taixing, China: 218 esophagus, 206 stomach, 204 liver cancer cases and 415 controls). rs1061302 was associated with cancers of the lung [adjusted odds ratio (OR(adj)) = 1.6, 95% confidence interval (CI): 1.2, 2.4], larynx (OR(adj) = 0.56, 95% CI: 0.32, 0.97) and liver (OR(adj) = 1.7, 95% CI: 1.0, 2.9). Additionally, positive associations were found for rs709816 with bladder cancer (OR(adj) = 4.2, 95% CI: 1.4, 12) and rs1063054 with lung cancer (OR(adj) = 1.6, 95% CI: 1.0, 2.3). Some associations in lung and stomach cancers varied with smoking status. CAC haplotype was positively associated with smoking-related cancers: lung (OR(adj) = 1.7, 95% CI: 1.1, 2.9) and UADT (OR(adj) = 2.0, 95% CI: 1.1, 3.7), specifically, oropharynx (OR(adj) = 2.1, 95% CI: 1.0, 4.2) and larynx (OR(adj) = 4.8, 95% CI: 1.7, 14). Bayesian false-discovery probabilities were calculated to assess Type I error. It appears that NBS1 polymorphisms and haplotypes may be associated with smoking-related cancers and that these associations may differ by smoking status. Our findings also suggest that single-nucleotide polymorphisms located in the binding region of the MRE-RAD50-NBS1 complex or microRNA targeted pathways may influence tumor development. These hypotheses should be further examined in functional studies.
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Affiliation(s)
- Sungshim L Park
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, 71-225 CHS, Box 951772, 650 Charles E Young Drive, South, Los Angeles, CA 90095-1772, USA
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Pouliot F, Anterasian C, Li Z, Shuch B, Calimlim B, Pantuck A, Belldegrun A. 1792 VALIDATION OF CA-IX POLYMORPHISM RS12553173 AS AN INDEPENDENT PROGNOSTIC FACTOR OF OVERALL SURVIVAL IN METASTATIC CLEAR CELL RENAL CELL CARCINOMA. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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McClure T, Chow D, Pantuck A, Schulam P, Belldegrun A, Lu D, Raman S. 1480 PERCUTANEOUS CT AND US GUIDED RADIOFREQUENCY ABLATION OF RENAL MASSES: LONG TERM EFFICACY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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